Drug interactions
Piroxicam + Warfarin
Severity: Major
Piroxicam and Warfarin: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Piroxicam inhibits platelet function and can cause gastrointestinal ulceration, markedly increasing the risk of serious bleeding in patients taking warfarin. The INR may not change, so the bleeding risk is not reflected by INR monitoring alone.
What this interaction means in plain words
Piroxicam and Warfarin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Piroxicam belongs to Musculoskeletal; Warfarin belongs to Cardiovascular.
Why it happens
Additive hemostatic impairment from NSAID antiplatelet effects and mucosal injury with vitamin K antagonist anticoagulation, with possible protein-binding or CYP2C9 contribution.
What to do
Avoid the combination and use paracetamol or another non-NSAID analgesic. If unavoidable, monitor INR closely, watch for bleeding and consider gastroprotection.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Piroxicam
- Ketorolac intranasal + Piroxicam Contraindicated
- Ketorolac + Piroxicam Contraindicated
- Aceclofenac + Piroxicam Major
- Acemetacin + Piroxicam Major
- Acetylsalicylic acid + Piroxicam Major
- Alteplase + Piroxicam Major
Other interactions of Warfarin
- Defibrotide + Warfarin Contraindicated
- Ketorolac + Warfarin Contraindicated
- Abciximab + Warfarin Major
- Acetylsalicylic acid + Warfarin Major
- Adagrasib + Warfarin Major
- Amiodarone + Warfarin Major
Frequently asked questions
Can I take Piroxicam with Warfarin?
MediHelp rates the interaction as major. Piroxicam and Warfarin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Piroxicam inhibits platelet function and can cause gastrointestinal ulceration, markedly increasing the risk of serious bleeding in patients taking warfarin. The INR may not change, so the bleeding risk is not reflected by INR monitoring alone.
How serious is the interaction between Piroxicam and Warfarin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and use paracetamol or another non-NSAID analgesic. If unavoidable, monitor INR closely, watch for bleeding and consider gastroprotection.
What other medicines interact with Piroxicam?
MediHelp also lists interactions of Piroxicam with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Piroxicam page.
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